State-funded Family Assistance and MassHealth Standard for Immigrants

MassHealth Family Assistance provides coverage for different groups including 100% state-funded coverage for certain lawfully present and PRUCOL immigrants who are not eligible for federally reimbursed Medicaid. Until recently, Family Assistance included few long term services and supports. MassHealth expanded the Family Assistance benefit in July 2020 and again on Nov 1, 2021. Also on Nov 1, 2021 it created a new pathway for elderly and disabled immigrants previously only eligible for state-funded Family Assistance to now obtain state-funded MassHealth Standard.

The July 2020 Changes to Family Assistance:

In July 2020 MassHealth expanded the benefits of Family Assistance to include up to 100 days of Nursing Facility services and up to100 days of service in a Chronic Rehabilitation Hospital. (Prior to July 1, 2020  only 30 days in a Chronic Disease Hospital and no Nursing Facility days had been covered in Family Assistance). The Provider Bulletins describing the July 2020 changes were: July 2020 Nursing Facility Provider Bulletin 149 and Chronic Disease and Rehab Inpatient Hospital Provider Bulletin 90 authorizing the  100 day benefit expansion of Family Assistance. They have since been superseded to reflect the Nov 1, 2021 expansion

The Nov 1, 2021 Changes to Family Assistance and creation of state-funded MassHealth Standard

In October 2021 MassHealth announced it will be expanding Family Assistance to include up to 6 months of Nursing Facility services effective Nov 1, 2021 It also announced that it will be providing the full range of community and facility-based long term services and supports available in MassHealth Standard and CommonHealth to medically eligible state-funded immigrants effective Nov 1, 2021. Attached is the November 2021 Eligibility Operation Memo 21-26 Pathway to Short-Term and Long-Term Care for Family Assistance Members .Initially, the agency  developed an assessment form for use by the ASAPs to determine when Family Assistance members meet the Nursing Home Level of Care (attached). Those who meet the Nursing Facility level of care may qualify for state-funded MassHealth Standard which they can use to pay for a long term stay in a nursing facility or Chronic Disease/Rehab Hospital OR they can use the full range of MassHealth Standard benefits available in the community.  Later, MassHealth released an Overview (attached) describing the process in more detail and explaining  how individuals who do not meet a Nursing Facility LOC but do meet the clinical criteria for Personal Care Attendant (PCA) services can qualify for state-funded MassHealth Standard in the community by submitting the PCA Supplement form instead of obtaining an assessment from an ASAP.

Additional Guidance released since Nov 1, 2021

On Dec 3, 2021 MassHealth released a more detailed Eligibility Policy Update  of the Nov 2021 policy change  attached as the "New LTSS Pathways External Summary"

In Jan 2022 MassHealth released provider bulletins regarding short term and long term care in a Chronic Disease Hospital or Nursing Facility superseding the earlier July 1, 2020 Bulletins

• Chronic Disease and Rehabilitation Inpatient Hospital Bulletin 97: Family Assistance Coverage Expansion for MassHealth Chronic Disease and Rehabilitation Hospitals – Updated
   
• Nursing Facility Bulletin 174: Family Assistance Coverage Expansion for Nursing Facility Services – Updated

https://www.mass.gov/lists/2022-masshealth-provider-bulletins

In Feb 2022 MassHealth produced an Overview describing the process for applicants and for current members 

• Attached are two documents providing an Overview of the process for seniors and people with disabilities to obtain state-funded MassHealth Standard. One document describes the process for new applicants and one for current Family Assistance members.
• People with disabilities under age 65  who do not meet a nursing home level of care should complete the ACA-3 application form, but in addition to being found disabled, will need to complete the PCA Supplement Form. The form is available at the MassHealth Member Form page in English and Spanish. https://www.mass.gov/service-details/masshealth-member-forms. For people 65 and older, the PCA form is attached to the SACA-2 Senior application form. 

In July 2023 Masshealth issued an updated eligibility operations memo 23-17  which clarified the categories of immigrants affected by the new policy but unfortunately did not add information about the process for qualifying for state-funded Standard or CommonHealth based on clinical eligibility for PCA services. MassHealth has told us this pathway remains available. However, the only written account of it are the Feb 2022 Overviews produced by MassHealth.